'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Nurses may be able to certify deaths

Nurses and paramedics could be able to certify cause of death in future under new procedures for death certification that ministers claim will cut GP workload.

The Home Office proposals tighten up death certification systems, but stop well short of Shipman Inquiry calls for detailed medical examinations of all deaths and a new post of medical coroner to be established.

Under the procedures released in a 'position paper' last week, paramedics or senior nurses will be allowed to verify deaths by collecting medical and circumstantial evidence.

GPs will still have to certify the cause of death for now, but the Home Office is to consider allowing verifiers to do so.

All deaths will be screened by a medical examiner, a qualified doctor independent of the NHS, backed by staff who would authorise burial and cremation.

The Home Office said the fact GPs were aware their certificate would be subject to scrutiny by medical examiners would 'deter careless or dishonest first certification'.

Coroners have also been given increased powers to seize papers from NHS and private GP premises.

Medical examiners will keep a database of deaths to identify regional trends.

Dr Gerard Panting, policy and communications director at the Medical Protection Society, said 'aberrant patterns' would be identified by medical examiners and PCTs.

He added: 'This is a reaction to a very, very abnormal set of events. Having said that the current system is ancient.'

Dr Maureen Baker, honorary secretary of the RCGP, said she was relieved the Government had not adopted the Shipman recommendations.

'The Shipman Inquiry proposals were looking for fairly detailed medical examinations of every death,' she said.

'The medical examiner model is a perfectly reasonable proposal.'

GPC deputy chair Dr Hamish Meldrum questioned Home Office claims that the new system would save money. He said: 'You can't have more work and not more costs'.

The position paper is still subject to consultation.

How death certification proposals

have developed

Shipman Inquiry recommendations

(July 2003)

lForm 1 completed by health professional recording facts surrounding death, including who was present